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CLINICAL RESEARCH: CARDIAC RESYNCHRONIZATION THERAPY

Benefit of Combined Resynchronization and Defibrillator Therapy in Heart Failure Patients With and Without Ventricular Arrhythmias

Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands

Manuscript received December 22, 2005; revised manuscript received April 7, 2006, accepted April 11, 2006.

^_* Reprint requests and correspondence: Dr. Martin J. Schalij, Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands. (Email: M.J.Schalij{at}LUMC.nl).

OBJECTIVES: We attempted to assess the efficacy of combined cardiac resynchronization therapy-implantable cardioverter-defibrillator (CRT-ICD) in heart failure patients with and without ventricular arrhythmias.

BACKGROUND: Because CRT and ICDs both lower all-cause mortality in patients with advanced heart failure, combination of both therapies in a single device is challenging.

METHODS: A total of 191 consecutive patients with advanced heart failure, left ventricular ejection fraction <35%, and a QRS duration >120 ms received CRT-ICD. Seventy-one patients had a history of ventricular arrhythmias (secondary prevention); 120 patients did not have prior ventricular arrhythmias (primary prevention). During follow-up, ICD therapy rate, clinical improvement after 6 months, and mortality rate were evaluated.

RESULTS: During follow-up (18 ± 4 months), primary prevention patients experienced less appropriate ICD therapies than secondary prevention patients (21% vs. 35%, p < 0.05). Multivariate analysis revealed, however, no predictors of ICD therapy. Furthermore, a similar, significant, improvement in clinical parameters was observed at 6 months in both groups. Also, the mortality rate in the primary prevention group was lower than in the secondary prevention group (3% vs. 18%, p < 0.05).

CONCLUSIONS: As 21% of the primary prevention patients and 35% of the secondary prevention patients experienced appropriate ICD therapy within 2 years after implant, and no predictors of ICD therapy could be identified, implantation of a CRT-ICD device should be considered in all patients eligible for CRT.

Abbreviations and Acronyms   ATP = antitachycardia pacing   CI = confidence interval   CRT = cardiac resynchronization therapy   HF = heart failure   HR = hazard ratio   ICD = implantable cardioverter-defibrillator   LV = left ventricle/ventricular   LVEF = left ventricular ejection fraction   NYHA = New York Heart Association   VF = ventricular fibrillation   VT = ventricular tachycardia

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